Cataract surgery practice and endophthalmitis prevention by Australian and New Zealand ophthalmologists

PURPOSE: Our aim was to examine current cataract surgery practice and the methods of chemoprophylaxis used in Australia and New Zealand, and to determine if these factors were related to self-reported incidence rates of postoperative endophthalmitis. METHODS: All Fellows and trainees of the Royal Australian and New Zealand College of Ophthalmologists were surveyed about their cataract surgery practices and methods of chemoprophylaxis for the prevention of postoperative endophthalmitis. Associations between self-reported incidence rates of endophthalmitis and clinical practice were examined using multivariate Poisson regression modelling. RESULTS: There were 731 respondents (81.6% of 896 surveyed) to the survey. Respondents reported a total of 162,120 cataract operations and 92 cases of endophthalmitis in 2003, a cumulative incidence of 0.057%. The self-reported incidence of endophthalmitis varied from 0.034% in Victoria to 0.56% in the Northern Territory. Topical antibiotics were used preoperatively by 46.7% compared with 97.4% postoperatively; while only 44.1% used subconjunctival antibiotics. The routine use of subconjunctival antibiotic halved the self-reported incidence of postoperative endophthalmitis (incidence rate ratio 0.53, 95% confidence interval 0.30-0.92). CONCLUSIONS: Subconjunctival antibiotics may be beneficial in the prevention of endophthalmitis after cataract surgery.     

Endophthalmitis following cataract surgery in Southwest Finland from 1987 to 2000

Purpose To investigate the incidence, causes, prevention, treatment and outcome of postoperative endophthalmitis (POE) following cataract surgery in south-west Finland from 1987 to 2000. Methods We reviewed the medical records of all patients with POE following cataract surgery treated in the hospital district of Southwest Finland from 1 January 1987 to 31 December 2000. Population-based annual incidence rates of cataract extractions and POE were calculated using the corrected population statistics of the hospital district. Results There were 29,350 cataract procedures during the 14-year period. POE developed in 47 patients. The annual incidence of cataract operations increased more than fivefold from 1987 (155 per 100,000 population) to the maximum in 1999 (930 per 100,000 population), whereas the annual incidence of postcataract endophthalmitis decreased from the maximum of 11.1 per 1,000 cataract extractions (1.91 per 100,000 population) in 1988 to the minimum of 0–0.6 per 1,000 cataract extractions in 1999 and 2000. POE occurred statistically significantly more frequently after extracapsular cataract extraction (ECCE) than after phacoemulsification (Phaco) (P=0.0006). Gram-positive bacteria were the most frequent cause of acute POE and Propionibacterium acnes was the most frequent reason for delayed-onset POE. The complications of POE after cataract surgery included visual loss to below 0.05 (25.5% of affected eyes), opacification of the cornea (21.3%), secondary cataract (40.4%), increase in intraocular pressure (29.8%), vitreous clouding (63.8%), and retinal detachment (6.4%). Nearly one half of the eyes achieved final visual acuity of 0.5 or better. Conclusions During the 14-year study period there was a shift from ECCE to Phaco, a fivefold increase in cataract extractions, and a decrease in the annual incidence of POE from 5.5–11.1 to 0–0.6 per 1,000 operations. Phaco was associated with a lower risk of POE than ECCE. None of the authors has a financial or proprietary interest in any material or method mentioned.     

Enucleation versus evisceration

The choice of enucleation and evisceration for removal of an eye remains controversial in certain circumstances. An international panel was asked to give their surgical management of two clinical cases that require either enucleation or evisceration. Case one follows multiple vitreoretinal procedures, and the risk of sympathetic ophthalmia is considered in the surgical management. Case two has had postoperative endophthalmitis, and the possibility of implant infection following insertion of an orbital implant with evisceration and enucleation is discussed.     

白内障超声乳化术不同切口与发生急性眼内炎的关系分析

目的分析白内障超声乳化术两种切口即透明角膜切口与巩膜隧道切口眼内炎发生的关系。方法选取2007年1月至2011年6月在我院接受白内障超声乳化术的1934例(2061眼),比较分析其切口与眼内炎发病率的相关性。结果 2061眼发生9眼眼内炎,总发病率为0.437%。其中8眼为透明角膜切口,1眼为巩膜隧道切口,发病率分别为0.779%、0.097%。两种切口的眼内炎发病率有明显差别。透明角膜切口较巩膜隧道切口易发生眼内炎。结论白内障超声乳化术中手术切口与眼内炎的发生有显著相关性,采用巩膜隧道切口可减少眼内炎的发生率。     

外伤性眼内炎39例诊疗分析

目的:分析外伤性眼内炎病原学及治疗方法。方法:对2010-09/2012-08我院收治的39例39眼外伤性眼内炎患者的病原学检查、治疗方法、治疗效果进行回顾性分析。结果:检出病原菌18例,总检出率为46%(18/39),涂片检查结果中Gram阳性(G+)球菌12例,占67%(12/18),G+杆菌4例,占22%(4/18)。视力提高者20例(51%),视力不变者8例(21%),视力下降者7例(18%),视力检查不配合者4例(10%)。结论:外伤性眼内炎尽早行病原学检查,指导临床用药;玻璃体腔注药及玻璃体切除术是治疗眼内炎的有效方法。     

“复明一号”白内障扶贫复明术后感染性眼内炎的临床分析

目的:探讨大批量白内障扶贫复明手术术后感染性眼内炎的防治方法。方法:回顾性分析"复明一号"1996-07/2011-08完成的30312例贫困白内障患者扶贫复明手术后9例感染性眼内炎患者的病例特点和治疗经过。结果:贫困白内障患者30312例复明手术后9例并发眼内炎,发病率为0.03%。经过药物及手术治疗,7例感染被控制,视力不同程度恢复,2例眼球摘除。结论:大批量白内障扶贫复明手术需要医生术前细致筛查患者,严格掌握手术适应证;强化手术车的消毒管理,规范围手术期的处理,提高手术技能;发生眼内炎后应积极救治,尽早行玻璃体腔注射抗生素及玻璃体切除术,以挽救患者的视力。     

Clinical features of bleb‐related infection: a 5‐year survey in Japan

Purpose: To present clinical features and microbial data for bleb‐related infections obtained by the 5‐year‐long Japan Glaucoma Society Survey of Bleb‐related Infection (JGSSBI). Methods: This multicentre prospective observational study was conducted in 82 clinical centres in Japan. A total of 170 bleb‐related infections developed in 157 eyes of 156 patients during a 5‐year period. The ophthalmological and microbial data were analysed. Results: The patient age at first infection was 59.3 ± 17.7 years [mean ± standard deviation (SD)], and the period between the last glaucoma surgery and the first infection was 6.9 ± 5.8 years (mean ± SD; range: 0.3–41 years). Bleb leakage was noted significantly more frequently in eyes with repeated infections. The stage of infection at diagnosis was stage I in 91 infections (54%), stage II in 30 infections (18%), stage IIIa in 18 infections (11%), and stage IIIb in 31 infections (18%). Staphylococcus species were the most frequently isolated microbe (41%), followed by Streptococcus species (32%). Streptococcus species, coagulase‐negative Staphylococcus, Haemophilus influenzae, and Enterococcus species were the major bacteria isolated in the late‐stage infections. Conclusions: The JGSSBI project has revealed several characteristics of bleb‐related infection in Japan, which include the significance of bleb leakage in the development of repeated infections and the distribution of bacterial isolates.     

Delayed Sterile Endophthalmitis after Glaucoma Drainage Implantation

Glaucoma drainage devices are being used with increasing frequency for patients. Sterile endophthalmitis after implantation has been reported. Unlike traditional trabeculectomy surgery, the persistence of an implant may be contributory. As glaucoma specialists consider emerging technologies in implantable glaucoma drainage devices, it is important to understand that sterile endophthalmitis may be associated with these devices.     

Long-term immunosuppressive treatment of serpiginous choroiditis

Objective: To determine the efficacy of immunosuppressive treatment in serpiginous choroiditis. Design: The clinical courses were reviewed of six consecutive patients (12 eyes) with vision-threatening, steroid-dependent/resistant serpiginous choroiditis treated with a combination of immunosuppressive agents including azathioprine, cyclosporine, and cyclophosphamide. All patients underwent treatment for at least 12 months. Results: The follow-up period ranged from 17 to 105 months (mean 57, median 43). All patients were able to taper oral steroids. Five patients discontinued all immunosuppressive medications after a treatment period of 12 to 69 months (mean 39 months). Immunosuppressive treatment was continued in one patient at a ‘low’ maintenance dose. Ten eyes had improved visual acuities, while vision remained impaired in two due to macular scars. Recurrence was noted in two patients when an attempt was made to decrease the dose of immunosuppressive medication. Two patients experienced side effects which were reversed by decreasing the dose of the medications. Conclusion: Long-term immunosuppressive treatment appears to prolong remission and preserve vision in patients with serpiginous choroiditis.     

Visual Recovery Following Mycobacterium chelonae Endophthalmitis

Following uncomplicated cataract surgery, a patient receiving etanercept for psoriatic arthritis developed Mycobacterium chelonae endophthalmitis. Vitrectomy, capsulectomy, and intraocular lens removal was followed by intravitreal amikacin, topical gatifloxacin, intravenous imipenem, and oral clarithromycin for six months. The patient achieved a final corrected visual acuity of 20/20. Etanercept has been implicated in the development of numerous, severe granulomatous infections, though not previously with M. chelonae. This represents the first reported case of visual recovery following M. chelonae endophthalmitis.